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Midwives: Rural Areas in Developing Countries Not Appealing

I have often said that while my immediate focus is to combat birth-related infections in remote villages in Southern Laos, my longer term goal is to fund midwifery training.  But how do you ensure that midwives trained in the relative prosperity and comfort of the capital Vientaine return to their villages?  This study examines this exact issue in Ghana and reveals that it’s not easy.

The staffing of public sector health facilities in remote rural areas is a serious challenge for many ministries of health in low- and middle-income countries.

Results
Three themes were identified through a broad inductive process: 1) social amenities; 2) professional life; and 3) further education/career advancement. Together they create the
overarching theme, quality of life, we use to describe the influences on midwifery students’ decision to accept a rural posting following graduation.

Conclusions
In countries where there are too few health workers, deployment of midwives to rural postings is a continuing challenge. Until more midwives are attracted to work in rural, remote areas health inequities will exist and the targeted reduction for maternal mortality will remain elusive.

As an aside, I am shocked to see that Ghana actually has much better maternal and infant stats than Laos (400 per 100k, 80% give birth alone, 27% antenatal care):

Maternal death in Ghana is currently estimated at 350 per 100 000, in part a reflection of the low rates of skilled support during birth [13]. According to the Demographic Health Survey,
43% of Ghanaian women give birth alone or with a non-skilled attendant [14] although 62.8% of women surveyed had attended the minimum standard of four antenatal visits [15].

Fundraising for Clean Birth Kits at the Farmer’s Market?

What do sterile birthing supplies have in common with locally grown produce?

Perhaps not much on the surface.  But farmer’s markets, like the Upper State Street Market in my neighborhood, draw people who are aware, concerned about health and motivated to engage in the community.  The pace of the market is slow and social.  People come for the food but they are interested in seeing what else is on offer.

I found it easy to draw market goers to my table and engage them in a brief conversation about birth kits.  Nine out of ten gave me the $5 donation, which covers the cost of one clean birth kit and training, that I was after.

It’s a fun, community-focused way to get out the word about your cause and a pleasant way to spend a morning.  Thanks to Natalie Peña, Market Manager at the Upper State Street Farm Market, for inviting me to participate and making me feel so welcome.

I’ll be back on September 8  from 10-1 to chat about birth kits and give a yoga demo (My classes at The Fitness Haven on State St. benefit cleanbirth.org too!)

So come on out, buy some veg, do some yoga and support women in Laos!

Where else can you do all that in one place?

How to Get Girls Involved in Improving Maternal Health

This week a CleanBirth.org gained a highly-motivated high school intern.  Thanks Marla!  I know that your passion and energy will make a difference.

Before bringing Marla on-board, I researched projects motivating youth from the US to support youth in the developing world.   I love the UN’s Girl Up campaign, which shows in an engaging, accessible way how  (and why) girls can help their peers around the world.  Marla said that she could “relate to” the Girl Up video on utube.  That’s a big accomplishment — crossing the divide between US teens and girls in Africa.  Making kids feel connected to other people’s suffering in a way that empowers, not alienates.

An article by Scott Seider at Boston University “Social Justice in the Suburbs: Engaging Privileged Youth in Social Action” talks about the need to educate students about these issues in the right way.  In his study of “83 high school students from an affluent Boston suburb” taking a course on social justice, he found that kids can feel overwhelmed by the hugeness of poverty, protective of their own wealth, and alienated from both the poor and those working to fight poverty.  Too much negative information can cause them to stop listening.  What’s need is smaller a dose information and bigger one of hope.

As an adult, the issues surrounding poverty seem too huge. That is why I cose clean birth kits: they are tangible and specific; they aim to stamp out a particular problem.  I’m not taking on global maternal health, instead I’m focused on birth-related infections in 50 villages in Southern Laos. Because I can do that.

Marla and I will bear these lessons in mind as we reach out to her peers.  She has shared that smaller group settings are more conducive to question-asking and getting people interested.  So we’ll do that.  We will keep the focus positive and show the kids that, though poverty is overwhelming, there are things we can do.

Clean Birth Kits and hemorrhage prevention

While I wait to hear from my partner org in Laos about the arrival of the kits, I think about fundraising of course and about my future goals for the project.

Ultimately, I want to support efforts(i.e. raise money) to train midwives.

Also, once the kits are being widely used, I would like health workers to have access to blood mats and misprostol.

Postpartum hemorrhage (PPH) is responsible for around 25% of maternal mortality worldwide (WHO, 2007).   Clean Birth Kit can/should include a blood mat and Misoprostol.

Here’s more from Maternova’s site:

CCDRB with Pathfinder and others conducted a large operations research study to determine the efficacy and acceptability of the blood mat and misoprostol as additions to ‘clean delivery kits.’ They found that women were able to use the mat to identify postpartum hemorrhage and administer the misoprostol to themselves. 96% of the women interviewed after the study had used the Quaiyum blood mat to identify postpartum hemorrhage and would use it again.

“The key to cutting the maternal death rate by a third”

The answer is contraception.  P.S. In 1995 55% of international population assistance  was earmarked for contraception.  By 2008 it was 6%.

Here’s the whole, short article.  Worth a read.

 

The key to cutting the maternal death rate by a third

By Laura Shin | July 16, 2012, 3:05 AM PDT

A new study has concluded that providing contraception to women in need of it in developing countries would cut the global maternal mortality rate by almost one third.The study, published in The Lancet and funded by the Bill and Melinda Gates Foundation, is reinvigorating the push to combat maternal deaths, an issue that has been overshadowed in recent years by the fight against AIDS and ideological battles.The study was published last week just before an international conference organized by the British Government and the Gates Foundation, during which 20 developing countries committed to help deliver contraceptives to an additional 120 million women and girls, which is estimated to cost $4.3 billion.

This represents a new influx of cash to an issue that, in 1995, represented 55% of international population assistance, but by 2008 comprised only 6% of such funding. (Spending on HIV/AIDS accounted for 74% of such funding in 2008.)

The study

Using maternal mortality and survey data from the United Nations and the World Health Organization, the researchers estimated that 342,200 women died of maternal causes in 2008. The researchers, of the Bloomberg School of Public Health at Johns Hopkins, also concluded that contraception prevented an additional 272,000 maternal deaths.

Finally, they estimated that another 104,000 maternal deaths a year could be averted by providing contraception to women who want it but don’t have access to it.

The study states that birth control reduces maternal mortality for several reasons:

•           It delays first pregnancies, which are especially risky in very young women

•           It reduces the number of unsafe abortions, which are responsible for 13% of all maternal deaths in developing countries

•           It cuts the number of pregnancies that are too closely spaced to each other in the same mother

The researchers acknowledged a weakness in their study: that records of maternal mortality in developing countries could be unreliable.

Melinda Gates has pushed to cut the number of maternal deaths, saying in April:

Somewhere along the way we got confused by our own conversation and we stopped trying to save these lives. We’re not talking about abortion. We’re not talking about population control. What I’m talking about is giving women the power to save their lives.

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